To Explore How To Establish A New Community-based Systemic Model Detecting And Managing People Living With HIV/AIDS (PLWHA) Effectively

Research objectiveTo develop community-based VCT/PITC service and establish a new systemic model detecting and managing People Living With HIV/AIDS(PLWHA) effectively in areas with high HIV prevalence.Research methodsBoth quantitative and qualitative methods were adopted. Random sampling in cluster was used to select those 1192 study subjects and face to face interview was carried out adopting anonymous questionnaires. Qualitative research methods were adopted including personal interview and panel discussion. In areas with high HIV prevalence of Hubei Province,China,Xiangfan City and Shiyan City,11 Medical and health services staffs were interviewed,and 6 experts and members of the project team,Xiangfan City, and 5 experts and members of the project team, Shiyan City, were organized to discuss in panel.Research resultsQuantitative result:26.3% of those subjects had heard of and 4.9% had used of VCT/PITC service. There were not only advantages but also difficulties that can be overcome to develop community-based VCT/PITC service.Advantages and problems in the community-based model:A community is where the residents dwell in and are familiar with. Thus, the community-based VCT/PITC services have better convenience and availability. We learned in the interviews that some people had the awareness of and demands for receiving counseling and testing after high-risk behaviors but could get no help due to the lack of knowledge about where and how to take these services. "Those residents who need the service would easy to find them", if we developed the community-based VCT/PITC services near to them.The residents in the same community often have the same life styles and cultural backgrounds, better understanding and also more likely to trust each other. It had been shown that a role model or valued member of the community declaring that he or she had a test was important in reducing stigma and increasing the uptake of HIV test.If we establish community-based model to detect and then manage people living with HIV/AIDS effectively, information on the seropositives could be acquired more quickly and detailedly. And it can save traffic, time, manpower and other costs, and attains higher social benefits of governmental investment.The community health service network had been basically shaped in China. Parts of the community health service stations were well-established, with the ability to undertake HIV/AIDS prevention and control. Moreover, it had established health files for the residents with good management. The community health care personnel were adept at handling their everyday business and knew well of governmental "Four Frees and One Care" policy on the PLWHA. They developed not only health education but also behavioral intervention such as distributing condoms at amusement places. Pingxiangmen community health Service Station had set a good example of that.We expected the community-based model had quite a few advantages. But our investigation disclosed there were also some problems in the model.The conditions of developing the community-based VCT/PITC services in China were not quite mature or there were almost no community-based VCT/PITC services. Even if government develops such services, the residents would refuse to receive for worrying about "acquaintances would leak their privacy". Community-based AIDS prevention and treatment business was still being at a promotional level. A majority of people knew little of VCT/PITC service (awareness rate was 26.3%). And the uptake rate was also in a low stage. Only 4.9% of the population had ever used of the service. It discloses the low efficiency of our health education, and neither the quantity nor the quality of the health education was good enough. As knowledge affects attitude, and attitude affects behavior, we should make full use of the cultural and economic community advantages to develop excellent health education.VCT/PITC services were centralized in the charge of Centers for Disease Control and Prevention (CDC) and with detached administration and execution. The funding, manpower and technology were managed by different sections respectively. If the subordinate department met with difficulties, they had to submit their reports to several supervising authorities. It made the subordinate department and the supervising authorities difficult to communicate. CDC should decentralize to some extent if we develop the community-based VCT/PITC services in future. However, CDC should still centralizedly guide but not manage the other institutes. At the same time, the supervising sections in CDC should strengthen communicating with each other.In China, there were widespread problems for lack of funds and technical supports in VCT/PITC services. Some of community healthcare staff was not quite qualified for their business. Highly unbalanced developments with regional differences were key problem among the existing community healthcare institutions. Part of them had been well developed, competent to their work, but the other had just been set up. Even some of the latter healthcare staff were on secondment, not familiar with the business. Therefore we should establish "help with" responsive working relationships between the well-developed and the just been set up. And cross-community medical co-operation was necessary. Accordingly, the gaps should be minimized.It was viable to develop community-based business on fighting against HIV/AIDS depending on all social sectors under the governmental guidance, although there were lots of the existing difficulties.Research conclusionCommunity-based VCT/PITC service hadn't been developed. It's viable to develop community-based VCT/PITC service. So can elevate the availability and use rate of VCT/PITC service to detect and then manage People Living With HIV/AIDS (PLWHA) effectively. Health education should be strengthened and community-based VCT/PITC service should be developed. We plan to develop the community-based VCT/PITC services through three paths, including Strengthening managing the health files, community-based VCT/PITC clinics and workplace VCT/PITC services. Then we establish the community HIV health care centers constituted of 8 sectors to provide an overall management. Thus, we can detect and then manage PLWHA effectively with a new systemic community-based model.So can elevate the availability and use rate of VCT/PITC service to detect and manage People Living With HIV/AIDS (PLWHA) effectively.Research originalitiesThere were almost no community-based VCT and PITC services in China. The availability and use rate were low. We explore how to ste up a community-based model to detect and manage People Living With HIV/AIDS (PLWHA) effectively.